During National Nurses week we acknowledge the excellence and dedication of those who choose the nursing profession. I grew up surrounded by nurses in a nursing home that my family owned and operated. We lived in a rural area and my mother’s skills as a Registered Nurse also made her the go-to person for many emergencies around the village – cuts, burns and even broken bones, head injuries and emotional problems.

I can see my mother calmly cleaning and dressing a bloody wound after an accident with a broken glass and, on another occasion, carefully positioning a child’s possibly broken leg after a fall from a tree. Eventually, a doctor might arrive, but watching my mother and her colleagues in action, day after day, offered me firsthand knowledge that nurses were unsung heroines.

Nurses in war zones and military settings have done their job quietly and largely unnoticed as well, putting their lives in peril on the battlefield for centuries. Yet, little is known about their experiences in war or exactly how many participated. Even appropriate financial remuneration in the nursing profession has been meager and long in coming. Only at the end of the twentieth century did nurses’ pay, both in military and civilian life, begin to become commensurate with the risks and responsibilities of their jobs.

Many women served as nurses during the Revolutionary War, but they are barely mentioned in history books. The Second Continental Congress, heeding George Washington’s advice to establish a means of caring for wounded and sick soldiers, authorized the formation of hospitals. In July of 1775, congress initiated a plan to provide one nurse for every ten patients and a supervising matron for every ten nurses. But, nurses were not always easy to find and formal training was nonexistent. General Washington blamed the low compensation rate—originally $2 a month—for the shortage of nurses, but it’s more probable that a woman risked receiving a bad moral reputation if she wanted to be a nurse. Congress did increase nurses’ pay a year later, to $8 a month.

Louisa May Alcott, long before Little Women, had a brief career as an army nurse during the Civil War. Her first publication, Hospital Sketches, was a detailed account of her experience. Louisa was an unknown but zealous patriot when she arrived in Washington, DC, in 1862, to work in the Union Hotel Army Hospital. She had read Florence Nightingale’s Notes on Nursing and Dr. Home’s Report on Gunshot Wounds, but that was the extent of her training. She described in letters to her family that, on her first day, “…stretcher after stretcher arrived from the battle of Fredericksburg…each with a legless, armless or desperately wounded occupant.” Louisa cared for hundreds of soldiers with devastating wounds and loss of limbs, working with little more than soap, water, and whiskey.

Her descriptions were so vivid and evoked so much emotion about caring for the wounded, that the Union Army published her book and provided it to the families of soldiers. This small volume established her reputation as an author, but her experience devastated her health. She contracted Typhoid Pneumonia after six weeks and would suffer from the poisonous effects of treatment with mercury until her death in 1888.

She reported in her journal that she was pleased to receive ten dollars for her short stint in Washington, revealing that the pay had barely improved in one hundred years since the Revolutionary War. Approximately 6000 women served as nurses during the Civil War and their reward was largely the legacy of gratitude described in the letters and journals of the wounded.

Fifty years later, in 1901, the Army Nurse Corp was created during the Spanish-American War and nurses were appointed to work for three years but were not commissioned as army officers. The appointment could be renewed if their skills were satisfactory, but it would take two more wars and another fifty years for nurses to receive commissioned officer status in 1944.

I am on this earth because of the compassion of nurses. During World War I, my grandfather served in the British Army and ended up in a hospital in Malta after suffering the effects of mustard gas and severe wounds in France. The nurses suggested that he correspond with someone. He remembered a young woman he had met on a farm in Connecticut years before. The letters commenced and they married on his return, eventually creating my mother.

Growing up around nurses in the 1950s I was privy to occasional stories and vivid memories. One former army nurse would sit with me and my brothers at a picnic table during her break-time and launch into a story. She once described being one of sixty nurses, climbing over the side of a ship off the coast of North Africa and down an iron ladder into small assault boats. Each boat carried nurses, medical officers, and enlisted men. The nurses wore helmets and carried full packs containing bandages, medicine, gas masks, and canteen belts. Only their Red Cross arm bands and lack of weapons distinguished them from fighting troops. They waded ashore and huddled behind a sand dune while enemy snipers took potshots at them. Before the night was over, their commanding officer ordered them to an abandoned civilian hospital, where they began caring for casualties. There was no electricity or running water, and the only medical supplies available were those they had brought themselves. We jumped out of our seats when she described the rat-a-tat-tat of enemy fire overhead.

Nurses were not spared capture and imprisonment during the war. In 1945 U.S. troops liberated sixty-seven army nurses who had been imprisoned in Santo Tomas Internment Camp since 1942 and evacuated them to a convalescent hospital on Leyte where they recovered from malnutrition. Like many men who saw the worst of war, these women came home and slipped back into their communities and rarely shared their experiences.

The exact number of nurses who served in World War II is unknown, but they received 1,619 medals, citations, and commendations. Overall, 201 nurses died while serving in the Army in World War II.

During the Korean War, Army nurses served in medical units close to the front lines, in field hospitals, on army transport ships, hospital trains and at Mobile Army Surgical Hospitals (MASH). By chance, the general public has more knowledge of nursing services, especially during the Korean War, thanks to popular culture. The fictionalized depiction of a medical unit portrayed in the film, MASH, and a subsequent TV series featuring “Hot Lips” Hoolihan, offered a romanticized version of women nurses in wartime – but, at least it showed that they were there.

During the Vietnam War, on November 8, 1967, all restrictions to female officer careers were removed. Finally, members of the Women’s Army Corps and the Army Nurse Corps could receive the same promotions as those applied to men. Col. Anna Mae Hays achieved the rank of brigadier general on June 11, 1970. Again, the exact number is not known, but thousands of women served as nurses in Vietnam. The number killed in Vietnam is also unclear, ranging from seven to nine.

Nurses have served in untold numbers in wartime even before Florence Nightingale went to the Crimean War and became known as “the lady with the lamp.” I’ve been comforted by the thought that nurses were near the battlefields of Vietnam in 1969 to care for my husband in the brief moments he survived after being mortally wounded in a booby-trapped bunker. I may never know who they are, but I’m sure they eased his death with calm and compassion. I’m deeply grateful for all those who choose to be nurses.